Hospitals push for Medicaid expansion in Kansas

Topeka  Hospitals are hurting because Kansas hasn't expanded Medicaid coverage to serve more poor people, health officials said in urging lawmakers to make changes.

But a House committee didn't advance an expansion bill last week after hearing testimony about the measure's cost. Rep. Dan Hawkins, told The Wichita Eagle that the bill would remain alive, but he was unsure of its future. It's possible something could happen with it during the veto session in May.

The bill would strike language from an existing law that forbids the state from expanding Medicaid except by an act of the Legislature. Under the measure, state health officials would be authorized to apply for a waiver from the U.S. Department of Health and Human Services. There are no guarantees that a waiver would be approved, but federal officials have reached agreements with six states to add extra requirements to Medicaid eligibility or to give the private sector a role, The Topeka Capital-Journal reports.

Adults in Kansas qualify for Medicaid only if they have an income of less than 33 percent of the poverty line, or about $8,002 for a family of four, have a child or are pregnant, or have a "total" disability that is permanent. The bill would raise the income threshold to 138 percent of the poverty line, or $33,465 for the same family of four, and doesn't include a requirement that recipients have children or a disability.

Scott Brunner, a senior analyst with Kansas Health Institute, said about 182,000 adults in Kansas fall into a "coverage gap" because they earn too much to be eligible for Medicaid, but not enough to qualify for subsidies through the insurance exchange. Their options for care include doing without or using emergency rooms, which pass the costs onto hospitals and other patients, he said.

The bill's biggest challenge came when Susan Mosier, acting secretary for the Kansas Department of Health and Environment, testified that expanding Medicaid to cover more than 150,000 uninsured Kansans would cost the state an additional $2.4 billion from 2016 through 2025. Some lawmakers, however, said her numbers were inflated, The Eagle reported.

Thomas Hamilton, chief medical officer at St. Francis Health in Topeka, said a person who visits the emergency room for a major event can easily need thousands of dollars in care and diagnostic tests over multiple days, The Capital-Journal reported.

Randy Peterson, president and CEO of Stormont-Vail Healthcare in Topeka, said the hospital system provided about $33 million in uncompensated care in 2014, and expects that to rise to more than $42 million this year. That comes on top of about $10 million the system is losing annually in lower reimbursements under health care reform, which were supposed to have been offset by more patients being insured through Medicaid and the insurance exchanges, he said in a letter to the House committee. He said the reimbursement losses are "not sustainable."

In addition to the cost, Gov. Sam Brownback and many Republicans in the Legislature have declined to expand Medicaid in Kansas because they oppose President Barack Obama's health reform law.